Abstract
Purpose
To summarize the conservative treatment of neonatal hepatic hemangioma at one institute.
Patients and materials
Fifteen cases of neonatal hepatic hemangioma were managed in our hospital during the previous 5 years. Initial symptoms, combination symptoms, diagnosis, and treatment were analyzed.
Results
Initial symptoms were abdominal mass, hepatomegaly, jaundice, and pneumonia. Combination symptoms were multiple skin hemangiomas, pneumonia, and cardiac insufficiency. Ultrasound and CT showed the typical characteristics of the liver hemangioma. There were three types of hepatic hemangioma: nine cases had a single focus, four cases were multiple foci, and two had diffuse changes in the liver. The diameter of a single focus in this group was about 53–99 mm. Four cases of single focus received resection and two received biopsy. Six cases received corticosteroid treatment. The other five cases were kept under observation only. Those with cardiac insufficiency and pneumonia received diuretics and antibiotic treatment. One neonate with cardiac insufficiency and pneumonia had postoperative MODS and died. One patient having multi-focus in the liver gave up the treatment after biopsy. Other patients were followed-up at 5–17 months. Two cases that received total tumor resection did not have recurrence. In those who received conservative therapy, all hemangiomas disappeared within 1 year.
Conclusion
The diagnosis of hepatic hemangioma can be made from symptomology, ultrasound, and CT; pathologic samples are not necessary. Corticosteroid therapy is the widely used therapy. Proactive therapy for congestive heart failure is helpful for those endangering liver hemangioma. Surgery can increase the risk of complications and is not advised for treatment of neonatal hepatic hemangioma.
Similar content being viewed by others
References
Haydon E, Haydon G, Bramhall S et al (2005) Hepatic epithelioid haemangioendothelioma. J R Soc Med 98(8):364–365. doi:10.1258/jrsm.98.8.364
Ho J, Kendrick V, Dewey D et al (2005) New insight into the pathophysiology of severe hypothyroidism in an infant with multiple hepatic hemangiomas. J Pediatr Endocrinol Metab 18(5):511–514
Tsai HP, Jeng LB, Lee WC, Chen MF et al (2003) Clinical experience of hepatic hemangioma undergoing hepatic resection. Diges Disea Scien 48(5):916–920
Konrad D, Ellis G, Perlman K (2003) Spontaneous regression of severe acquired infantile hypothyroidism associated with multiple liver hemangiomas. J Pediatrics 112(6):1124–1126
Frieden IJ, Haggstrom AN, Drolet BA et al (2005) Infantile hemangiomas: current knowledge, future directions. In: Proceedings of a research workshop on infantile hemangiomas, 7–9 April 2005, Bethesda, MD, USA. Peidatr Dermatol 22(5):383–406
Siegel M (2001) Pediatric liver imaging. Semin Liver Dis 21:251–269. doi:10.1055/s-2001-15339
Regier TS, Ramji FG (2004) Pediatric hepatic hemangioma. Radiographics 24:1719–1724. doi:10.1148/rg.246035188
Hosokawa A, Maeda T, Tateishi U et al (2005) Hepatic hemangioma presenting atypical radiologic findings: a case report. Radiat Med 23(5):371–375
Kretschmar O, Knirsch W, Bernet V (2008) Interventional treatment of a symptomatic neonatal hepatic cavernous hemangiomausing the Amplatzer vascular plug. Cardiovasc Intervent Radiol 31(2):411–414. doi:10.1007/s00270-006-0123-7
Dachman AH, Lichenstein JE, Friedman AC et al (1983) Infantile hemangioendothelioma of the liver. A radiologic-pathologic-clinical correlation. AJR Am J Roentgenol 140:1091–1096
Mo JQ, Dimashkieh HH, Bove KE (2004) GLUT1 endothelial reactivity distinguishes hepatic infantile hemangioma from congenital hepatic vascular malformation with associated capillary proliferation. Hum Pathol 35(2):200–209. doi:10.1016/j.humpath.2003.09.017
Kinoshita Y, Tajiri T, Souzaki R et al (2008) Diagnostic value of lectin reactive alpha-fetoprotein for neoinfantile hepatic tumors and malignant germ cell tumors: preliminary study. J Pediatr Hematol Oncol 30(6):447–450. doi:10.1097/MPH.0b013e31816916ad
Christison-Lagay ER, Burrows P, Alomari A et al (2007) Hepatic hemangiomas: subtype classification and development of a clinical practice algorithm and registry. J Pediatr Surg 42:62–68. doi:10.1016/j.jpedsurg.2006.09.041
Boon LM, Burrows PE, Paltiel HJ et al (1996) Hepatic vascular anomalies in infancy: a twenty-seven-year experience. J Pediatr 129(3):346–354. doi:10.1016/S0022-3476(96)70065-3
Ekinci S, Karnak I, Tanyel FC et al (2006) Hepatic lobectomies in children: experience of a center in the light of changing management of malignant liver tumors. Pediatr Surg Int 22(3):228–232. doi:10.1007/s00383-005-1608-1
Rowan W, John H, Debra B et al (2004) Congenital infantile hepatic hemangioendothelioma type II treated with orthotopic liver transplantation. J Pediatr Hematol Oncol 26:121–123. doi:10.1097/00043426-200402000-00014
Draper H, Diamond IR, Temple M et al (2008) Multimodal management of endangering hepatic hemangioma: impact on transplant avoidance: a descriptive case series. J Pediatr Surg 43(1):120–125. doi:10.1016/j.jpedsurg.2007.09.030
Huang SA, Tu HM, Harney JW et al (2000) Severe hypothyroidism caused by type 3 iodothyronine deiodinase in infantile hemangiomas. N Engl J Med 343:185–189. doi:10.1056/NEJM200007203430305
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dong, Kr., Zheng, S. & Xiao, X. Conservative management of neonatal hepatic hemangioma: a report from one institute. Pediatr Surg Int 25, 493–498 (2009). https://doi.org/10.1007/s00383-009-2373-3
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-009-2373-3